Thousands of veterans in Hawaii have started to receive "Choice Cards" from the Department of Veterans Affairs that are meant to provide health care in the community as an alternative to long waits for VA appointments.
But a lot of uncertainty remains as to how the program will be implemented here, and what impact it will have on Hawaii’s medical care system.
Part of the confusion stems from the fact that Hawaii, Alaska and New Hampshire do not have actual VA medical centers, according to the VA. The other 47 states do have such medical centers, and that’s guiding new legislation for the vast majority of the country, the VA said.
The new Veterans Access, Choice and Accountability Act of 2014, signed into law in August, mandates the provision of non-VA care for veterans unable to secure an appointment at a VA medical facility within 30 days or who reside more than 40 miles from the nearest VA facility, according to Congress.
But in Hawaii, which has a VA clinic and a "memorandum of understanding" with Tripler Army Medical Center, all veterans enrolled in the VA health care system as of Aug. 1 and recently discharged combat veterans will be receiving Choice Cards, the VA said.
Within the VA Pacific Islands Health Care System, which includes Hawaii, approximately 50,000 veterans will receive Choice Cards, said Patricia Matthews, a VA spokeswoman with the Pacific system.
Even before the Choice Act was passed, the VA referred some patients in Hawaii to community providers for care, the government agency said.
"Many details of the (Choice) program are still being worked out nationally. However, they will not impede a veteran’s choice to access the care they need," Matthews said.
George Greene, president and CEO of the Healthcare Association of Hawaii, said in an email that veterans "are an important patient population who have made a personal investment in keeping our country safe."
"The Healthcare Association of Hawaii believes that any initiative that would improve their health care is a good one," he said.
Asked, however, how the new Choice Cards might affect Hawaii’s medical system, Adria Estribou, a spokeswoman for the health care association, said, "I think it’s too early for us to comment on that."
The Veterans Choice Act includes a $10 billion fund from which the VA must pay for non-VA care.
The legislation "provides authorities, funding and other tools to better serve veterans in the short term," VA Secretary Bob McDonald said Nov. 5. "We are appreciative of this temporary measure to improve access while we build capacity within the VA system to better serve those who rely on us for health care."
Congress enacted the law in response to a national scandal involving a VA cover-up of long wait times for care.
The time a veteran waits in Hawaii and other parts of the Pacific to see a primary-care doctor for the first time dropped to 35 days — a reduction from 110 days since May 15, Wayne Pfeffer, director of the Pacific Islands system, said earlier this month in a letter to Hawaii’s congressional delegation.
Pfeffer also said the number of patients on an electronic waitlist for care decreased from more than 1,800 new patients to 37.
Some veterans still complain of three-month waits to see a VA doctor in Hawaii, however.
The first Choice Cards were mailed out Nov. 5, and a second batch started going out Monday, the VA said. Veterans in Honolulu and on Maui already have started receiving the cards, Matthews said.
Veterans receiving the Choice Card in Hawaii need to contact third-party administrator TriWest Healthcare Alliance, and TriWest will coordinate appointments, Matthews said.
The Choice Card provides a "safety net" for veterans who are on a VA waiting list, TriWest said on its website.
"The Choice Card is designed to supplement the care you receive at your VA medical facility, not replace or limit that care," TriWest said.
